JRS TUTORIALS
"JRS Bhawan" Durga Kund,Varanasi-221005 (U.P.)
Tel: 0542-2311922 , 2311777 E-mail : jrstutorials@satyam.net.in
 

APPLICATION FORM FOR IIT-JEE , MEDICAL , FOUNDATION COURSES & TEST SERIES

1.Stream *
2.Programme *
3.Name of the Candidate *
4. Date of Birth   (YYYY)*  5.Sex
6.Father's Name *
7.Father's Occupation *
8.Permanent Address *
9.Mobileno. (if any) *
10.Email address *
 
11.Guardian Name
12.Local Address
13.Telephone No. (if any)

14.Educational Qualification
Class Year Board/University Institution % Aggregate Marks
Xth
XIIth  

15.Mention the following

  1. DD Number :*
     
  2. DD Date :  *
     
  3. DD Amount : *
     
  4. Issuing Bank :*

 

 


Prabhash Srivastava (anukoola@satyam.net.in)